Blue cohosh is a flowering herb native to North America, growing in forested areas from the southeastern United States to Canada. Sometimes known as squaw root or papoose root, the herb may have been used medicinally by native Americans, although this belief is controversial. Other common names for the herb include yellow ginseng and blue ginseng. Blue cohosh should not be confused with the similarly named (but unrelated and much safer)
black cohosh
. Blue cohosh was used in the 1800s by European settlers and African Americans, primarily for gynecologic conditions.
1
Blue cohosh also has a reputation as an herb that can induce abortions, although concerns regarding its efficacy and safety make this use extremely ill-advised.
2
In addition, it has been used for the treatment of arthritis, cramps, epilepsy, inflammation of the uterus, hiccups, colic, and sore throat.

What Is Blue Cohosh Used for Today?

Blue cohosh is widely prescribed by herbalists and midwives. A 1999 survey published in the
Journal of Nurse-Midwifery
found that 64% of certified nurse-midwives who prescribe herbal medicines use blue cohosh to induce labor.
3
It has also been used for a wide variety of
menstrual problems
, including several for which it would not be logical to believe that the same treatment could help. For example, blue cohosh has been used to start menstrual periods that were late in coming and yet also to stop excessive or ongoing menstrual flow.

There is no credible evidence that blue cohosh is effective for any of the conditions for which it has been used. Furthermore, several published reports cite cases of serious side effects to infants apparently caused by blue cohosh. (See Safety Issues.)

Dosage

Blue cohosh is usually used as a tincture. Common dosages range from 5 to 10 drops taken every 2 to 4 hours.

Safety Issues

There are many serious safety concerns with blue cohosh.

Some of the compounds found in blue cohosh, such as caulophyllosaponin, methylcytosine, and caulosaponin, appear to constrict coronary vessels, limiting blood flow to the heart and reducing its ability to pump.
4
One published case report documents profound heart failure in a child born to a mother who used blue cohosh to induce labor.
5
Severe medical consequences were seen in another child as well.
6
Other blue cohosh constituents are known to interfere with the ability of a newly fertilized ovum to implant in the uterus, damage the uterus and thyroid, and cause severe birth defects in cattle and laboratory rats.
7,8,9

Given these reports, the availability of safe alternatives for stimulating labor, and the lack of studies to document the herb's efficacy and safety, NAT strongly advises against using blue cohosh.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Chandrasekhar K, Sarma GH. Observations on the effect of low and high doses of
Caulophyllum
on the ovaries and the consequential changes in the uterus and thyroid in rats [abstract].
J Reprod Fertil.
1974;38:236-237.